Signs and Symptoms

Watery liquid diarrhea 3-15 episodes per day is the most common symptom

Other symptoms for mild-moderate disease include:

Fever

Loss of appetite

Nausea

Abdominal pain/tenderness

Complications of severe disease

Pseudomembranous colitis

Toxic megacolon

Colon perforation

Ileus

Death (rare)

Transmission

Transmission of C. difficile occurs through the fecal-oral route

C. difficile spores can be transmitted to patients via the hands of healthcare personnel who have touched a contaminated surface or item

Any environmental surface can transmit C. difficile spores which are highly resistant to cleaning and disinfection measures.

C. difficile is a fastidious anaerobe that dies rapidly in its vegetative state

C. difficile spores can remain in the environment for days to months and are highly resistant to cleaning and disinfection measures

Diagnosis

CDI should be considered in any patient with watery diarrhea or abdominal pain following:

antibiotic exposure within previous 3 months
and/or

exposure to a healthcare setting within the past 3 months

Due to the changing epidemiology of C. difficile, consider CDI in patient with diarrhea lasting longer than 3 days with fever and/or abdominal pain in the absence of recent antibiotic use or healthcare exposure.

C. difficile may also be diagnosed through the endoscopic identification of pseudomembranes.